What question did this study set out to answer?

To evaluate changes in glycated haemoglobin (HbA1c) after starting hybrid closed-loop insulin pump therapy in children and young people with elevated HbA1c.

June 19, 2026

Real-world outcomes of hybrid closed-loop insulin pump therapy in UK children and young people with type 1 diabetes and high HbA1c: a multicentre retrospective cohort study

Key Points

To evaluate changes in glycated haemoglobin (HbA1c) after starting hybrid closed-loop insulin pump therapy in children and young people with elevated HbA1c.
Retrospective multicentre observational cohort study
Included CYP aged ≤19 years with HbA1c ≥69 mmol/mol before HCL initiation
Analysis of HbA1c changes at baseline, 3 months, and 12 months following therapy initiation.
HbA1c decreased from a mean of 82.5 mmol/mol at baseline to 72.8 mmol/mol at 3 months (p<0.001)
Mean HbA1c remained stable at 69.3 mmol/mol at 12 months
Hospital admissions for diabetes decreased overall after HCL initiation.

Abstract

Objective To evaluate changes in glycated haemoglobin (HbA1c) following initiation of hybrid closed-loop (HCL) insulin pump therapy in children and young people (CYP) with previously elevated HbA1c in a real-world multicentre setting. Design Retrospective multicentre observational cohort study. Setting 13 National Health Service paediatric diabetes units within a regional diabetes network in England, UK. Patients CYP aged ≤19 years with type 1 diabetes of more than 1 year’s duration and HbA1c ≥69 mmol/mol at the time of HCL initiation and at least 3 months prior. Interventions Initiation of HCL insulin pump therapy. Main outcome measures Primary outcome was change in HbA1c following HCL initiation. Secondary outcomes included subgroup and pump system comparisons and changes in diabetes-related hospital admissions. Results A total of 220 participants were included. HbA1c decreased significantly following HCL initiation (p100 mmol/mol) and in participants transitioning from multiple daily injections. Outcomes were similar across HCL pump systems, and diabetes-related hospital admissions decreased overall following HCL initiation. Conclusions In this large, real-world cohort of CYP with high HbA1c, initiation of HCL therapy was associated with sustained improvements in glycaemic control and fewer diabetes-related hospital admissions, supporting its use in this high-risk population.

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